Dr William Portuese
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Seattle Rhinoplasty Surgeon
Nasal Surgery Information

There are four reasons that patients undergo nasal surgery.

  • A broken nose
  • A breathing problem
  • Sinus issues / surgery
  • Cosmetic Rhinoplasty

These are four distinctly separate operations that can be performed individually or in combination.

A broken nose can be fixed, straightened and/or repaired through nasal surgery. A broken nose can come from many different types of injuries such as basketball or soccer; it takes a blunt force injury to fracture the nasal bones and cause the nose to be in misalignment. In the majority of cases where the nose bone is broken, the septum will also be fractured, creating a breathing problem and the repair of the deviated septum will be performed simultaneously. Repairing a broken nose is an outpatient procedure that takes about an hour under general anesthesia in our Seattle Rhinoplasty Center. Our anesthesiologists are board certified and come from Swedish Medical Center. In many instances, the upper lateral cartilages on one or both sides have been fractured off the nasal bones and small cartilaginous spreader grafts harvested from the internal portion of the nose are fashioned and placed underneath the cartilage to realign the nasal cartilage and nasal bones together to improve airflow through the nose. The procedure requires re-breaking the nasal bones through osteotomies, re-aligning the nasal pyramid and in addition, repairing any internal deviations for airflow management. A cast is then applied across the nose, however, there is NO packing placed inside the nose. Then patients are transferred to our recovery room for another hour or so before being discharged to home with their caretaker.

A deviated septum would be the cause for patients who are undergoing nasal surgery simply for breathing. The deviated septum can be caused congenitally in patients who are just born that way or it can be from a traumatic injury. The deviation of the septum, whether from congenital or traumatic injury, is repaired by making an incision approximately 0.5 inch long on the inside of the nose, usually the left side, lifting the skin of the internal portion of the nose off of the bone spur or deviation. The bone spur and deviation fracture is then repaired and re-straightened, re-aligned and sometimes removed. This is all nonstructural so it does not affect the integrity of the nose. The incision is then closed with two sutures that are dissolvable and there is no packing placed on the inside of the nose. If the deviation is from a traumatic injury to the nose, the septum on the internal portion of the nose can easily be fractured. This will require reduction of the nasal fracture, which is different than a septoplasty procedure. In the majority of cases when patients are undergoing nasal obstructive surgery, the turbinates are also a compounding issue. The inferior turbinates become hypertrophied and swollen due to many physiologic factors such as sinusitis, allergies, air pressure and environmental issues. These are also made smaller by trimming the tissues of the inferior turbinates and outfracturing them to improve the airflow dynamics through the nose. Patients do experience significant nasal obstruction for the first week and moderate obstruction in the second week. Finally by the third week, patients will start to breathe much better through their nose and the sense of smell will improve as well. This is an uncomfortable procedure, but not a painful one.

Sinus surgery is performed to remove polyps from the internal portion of the nose. The polyps are caused fro many different reasons, but the many cause is allergies, so the polyps are called allergic nasal polyps. Endoscopic sinus surgery is done when symptoms such as repetitive sinus infections and a decreased sense of smell become chronic in nature for usually longer that three to six months and patients are miserable. The endoscopic sinus surgery involves using telescopes placed on the inside of the nose and opening up natural windows inside the four-paired sinuses; the maxillary, sphenoid, ethmoid and frontal sinuses. A CAT scan (a three dimensional x ray) of the paranasal sinuses has to be performed in order to guide Dr. Portuese to the sinuses that must be addressed. Most patients have eight sinuses and some only require two sinuses to be opened. The majority of the obstruction occurs in the ostiomeatal complex area where sinuses drain naturally. The sinus drainage pathway is usually quite narrow and polyps from allergies create obstruction and drainage and chronic sinusitis. It is also important to consider medical management of the sinuses which include nasal sprays, antihistamines, decongestants, nasal irrigations, allergy testing, immunotherapy and avoidance of all environmental allergens.

The fourth consideration for nasal surgery is cosmetic Rhinoplasty. The cosmetic Rhinoplasty operation is performed to improve the aesthetic nature of the nose. Typically a large hump is removed from the bridge and the nasal sidewalls are narrowed to better balance the nose. The tip cartilages are usually also addressed to refine the nasal tip, including removal of cartilage or sewing of the tip cartilages to effect change. The tip must balance with the remainder of the nose. There are multiple cartilage grafts and surgical techniques to make a long nose short or a short nose long, as well as making a wide nose narrow and a narrow nose wider. These different cartilage grafting and surgical techniques can be performed through both an open or closed Rhinoplasty and there is no packing placed on the inside of the nose. Cosmetic Rhinoplasty is performed under general anesthesia in our outpatient Medicare certified surgery center under the supervision of a board certified physician anesthesiologist at The Seattle Rhinoplasty Center.


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© 2007 Dr William Portuese MD